4J Hr 15 16 Iep Timelogworkone Page 1 of 2
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2015/2016 Non-ESS Licensed IEP Time Log Revised 4/8/18 Form Owner: Human Resources Form Location: http://www.4j.lane.edu/files/forms/HR/4J_HR_IEP_Time_Log.doc
USER INSTRUCTIONS Form Purpose: Non-ESS teachers use this form to request payment for up to six hours of additional compensation based on their per diem rate, as provided in article 13.8.4 of the 2014-2017 agreement between Eugene School District 4J and the Eugene Education Association. How to Complete this Form: Fill out this form online. Alternately, print this form and complete it by hand. How to Submit this Form: Submit this form either electronically or on paper. Where to Send this Form: Email the completed form to [email protected] or submit a hard copy to Human Resources. Deadline: Forms will be accepted April 25, 2016 through June 10, 2016. Forms must be turned in to Human Resources by 5:00 pm on June 10, 2016. Payment will be included on the June 30, 2016 pay check. Additional Information: Meeting time will be accumulated in 15 minute increments. Participating in IEP meetings during scheduled planning days, scheduled preparation time, or outside the member’s work day qualifies as log-able. In the event total requests for payment exceed $20,000, compensation will be prorated. If you are attending a scheduled IEP meeting after June 10, 2016, please estimate the amount of meeting time needed on this form. (It is assumed that each meeting would be at least one hour).
EMPLOYEE INFORMATION – Fill Out Completely Last Name First Name Employee #
IEP TIME LOG – Fill Out Completely Date Site Beginning Time & Ending Time EXAMPLE in 15 minute increments
10/18/2014 Kennedy Middle School 4:30 – 4:45 pm
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
4j_hr_15_16_iep_timelogworkone.doc Page 1 of 2 IEP TIME LOG (Continued)
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
Date Site Beginning Time & Ending Time in 15 minute increments
SIGNATURE required if submitted in hard copy. NO SIGNATURE required if submitted electronically.
______Signature Date Submitted
4j_hr_15_16_iep_timelogworkone.doc Page 2 of 2